Provider Demographics
NPI:1346464617
Name:ARCHER, TONYA K (FNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:K
Last Name:ARCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:K
Other - Last Name:BRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NC
Mailing Address - Zip Code:27820-0348
Mailing Address - Country:US
Mailing Address - Phone:252-585-8113
Mailing Address - Fax:252-585-0274
Practice Address - Street 1:111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NC
Practice Address - Zip Code:27820
Practice Address - Country:US
Practice Address - Phone:252-585-1134
Practice Address - Fax:252-585-0274
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2596358GMedicare ID - Type Unspecified
S45738Medicare UPIN